帕立骨化醇对维持性血液透析伴继发性甲状旁腺功能亢进患者的保护作用

Protective effect of paricalcitol on microinflammatory state in patients with maintenance hemodialysis and secondary hyperparathyroidism

目的:探讨帕立骨化醇对维持性血液透析(MHD)伴继发性甲状旁腺功能亢进(SHPT)患者的保护作用。方法:选取103例行MHD的SHPT患者为研究对象,按治疗方式不同分为帕立骨化醇组(n=52)和骨化三醇组(n=51)。所有患者均行MHD治疗,在此基础上,帕立骨化醇组给予帕立骨化醇注射液进行治疗;骨化三醇组给予骨化三醇胶丸进行治疗,比较两组连续治疗8周后的钙磷代谢指标[全长甲状旁腺激素(iPTH)、钙、磷、钙磷乘积]、炎症指标[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、C反应蛋白(CRP)]、免疫功能指标(免疫球蛋白IgA、IgG、IgM)、骨代谢指标[β-胶原降解产物(β-CTX)、骨钙素N端中分子片段(N-MID)、Ⅰ型胶原氨基端延长肽(tPINP)]及治疗期间高血钙、高血磷不良反应发生情况。结果:治疗后,两组iPTH、血磷、TNF-α、IL-6、CRP、β-CTX、N-MID及tPINP水平均降低(P<0.05),血钙、钙磷乘积、IgA、IgG及IgM水平均升高(P<0.05),且两组间上述指标除IgA外,差异均有统计学意义(P<0.05);治疗期间,帕立骨化醇组高血钙、高血磷不良反应总发生率(9.62%)低于骨化三醇组(25.49%)(P<0.05)。结论:与骨化三醇比较,帕立骨化醇在降低MHD伴SHPT患者iPTH水平、调节钙磷代谢方面优势明显,可有效改善患者微炎症状态、免疫功能及骨代谢指标,且安全性较好,值得临床推广应用。

Objective:To explore the protective effect of paricalcitol on microinflammatory state in patients with secondary hyperparathyroidism(SHPT)undergoing maintenance hemodialysis(MHD).Methods:103 patients with SHPT undergoing MHD were selected as the research subjects,and the patients were divided into paricalcitol group(n=52)and calcitriol group(n=51)according to different treatment methods.All patients received MHD treatment,and on this basis,the paricalcitol group was treated with paricalcitol injection,and the calcitriol group was given calcitriol pills.The calcium-phosphorus metabolism indicators[intact parathyroid hormone(iPTH),calcium,phosphorus,calcium-phosphorus product],inflammatory indicators[tumor necrosis factor α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)],immune function indicators(immunoglobulins Ig A,Ig G,Ig M)and bone metabolism indicators[β-collagen degradation products(β-CTX),N-terminal midfragment of osteocalcin(N-MID),total type I collagen amino-terminal extension of peptides(tPINP)]after 8 weeks of continuous treatment and occurrence of adverse reactions of hypercalcemia and hyperphosphatemia during treatment were compared between the two groups.Results:After treatment,the levels of iPTH,blood phosphorus,TNF-α,IL-6,CRP,β-CTX,N-MID and tPINP in both groups were decreased(P<0.05),while the levels of blood calcium,calcium-phosphorus product,Ig A,Ig G and Ig M were increased(P<0.05),and the differences in the above indicators between the two groups,except for Ig A,were statistically significant(P<0.05).During treatment,the total incidence rate of adverse reactions such as hypercalcemia and hyperphosphatemia in paricalcitol group(9.62%)was lower than that in calcitriol group(25.49%,P<0.05).Conclusion:Compared with calcitriol,paricalcitol has more obvious advantages in reducing iPTH level and regulating calcium-phosphorus metabolism in MHD patients with SHPT,and paricalcitol can effectively improve the microinflammatory state,immune function and bone metabolism indicators,and it has good safety and is worthy of clinical promotion and application.